PubMed · 15006534
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F del Piñal. 2004. One step...backwards.. https://doi.org/10.1016/j.bjps.2003.11.019
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We report a case in which a patient developed malignant hyperthermia (MH) during surgery to replant his hand. His condition was stabilised without the need to cease the procedure which continued for a further 6 h. MH and traumatic amputation of a hand are both rare emergencies. This case demonstrates that, MH may be controlled to allow a lengthy operation to be completed.
The evolution of microsurgical technique has led to increasing success with pediatric replantation. The broader inclusion criteria for pediatric replantation, together with the greater technical demands of repair and the less favorable mechanism of pediatric amputations (crush-avulsion), yield a slightly lower overall survival rate than in adults. The superior nerve and soft tissue regenerative capacity of children appears to produce better functional outcomes. Nonetheless, the issue of cosmesis and developing self-image in a child may have ramifications beyond a simple calculus of range of motion and strength variables--hence the imperative that microsurgical salvage be attempted in pediatric upper-extremity amputations.
The replantation of fingertip amputation (through the nail bed) requires repair of the artery and vein on the palmar side. These structures are present in different planes, with the artery being deeper and the veins superficial. The authors believe that vascular repair in such cases is facilitated by stabilization of the amputated part by nail-bed repair alone. This provides a certain degree of flexibility, which allows for easier placement of clamps in the limited space available. Although Kirschner wires were not used for bony fixation, bony union was achieved in all five cases in which this technique was used.